From Expectations to Experience: A Comparison of Program Director Priorities to Resident Case Logs

Modern surgical education faces duty hour limits, productivity pressures, and growing subspecialization. Otolaryngology-head and neck surgery (OHNS) has experienced a shift to competency-based training creating challenges and opportunities. To become outcome-centered, programs must define essential competencies and align training with current practice. The current study surveyed program directors to identify essential OHNS procedures and analyzed Accreditation Council for Graduate Medical Education (ACGME) national case logs from recent graduates to assess exposure.

An electronic survey was distributed to OHNS program directors. Each of 111 procedures was classified as essential if at least 75% of program directors felt that residents should become competent performing the procedure prior to graduation. These procedures were examined in the ACGME case logs of 1480 OHNS residents who graduated between 2014 and 2019.

The survey response rate among program directors was 41% (50/122). Of 111 procedures, 47 were classified as essential. Select ACGME-defined key indicator procedures were not deemed essential procedures by program directors (rhinoplasty and ossiculoplasty). Case log analyses revealed wide variability in resident reported exposure to surgeries identified as essential. Nearly half of these procedures were logged fewer than 10 times during residency by recent graduates of OHNS training programs.

Resident recorded exposures to important OHNS surgeries varied greatly between trainees and many essential procedures are logged infrequently. Our findings have implications for refining ACGME key indicators and redesigning curricula to increase exposure to rare procedures, aligning training with the evolving practice within OHNS.

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